Evaluation of Neighborhood-Level Disadvantage and Cognition in Mexican American and Non-Hispanic White Adults 50 Years and Older in the US
Authors: Christina G. Wong, Justin B. Miller, Fan Zhang, Robert A. Rissman, Rema Raman, James R. Hall, Melissa Petersen, Kristine Yaffe, Amy J. Kind, Sid E. O’Bryant, Beau Ances, Ganesh Babulal, Robert Barber, Lisa Barnes, Matthew Borzage, Meredith Braskie, Amrita Cheema, Brad Christian, Ann Cohen, Michael Donohue, James Hall, Leigh Johnson, Amy Kind, Stephanie Large, Joe Lee, Jorge Llibre-Guerra, Mark Mapstone, David Mason, Michelle Mielke, Rajesh Nandy, Sid O'Bryant, Ozioma Okonkwo, Ray Palmer, Melissa Petersen, Nicole Phillips, Rema Raman, Robert Rissman, Monica Rivera Mindt, Yonggang Shi, Arthur Toga, Badri Vardarajan, Raul Vintimilla, Kristine Yaffe, Fan Zhang, Zhengyang Zhou
Journal: JAMA Network Open (2023)

Importance Understanding how socioeconomic factors are associated with cognitive aging is important for addressing health disparities in Alzheimer disease. Objective To examine the association of neighborhood disadvantage with cognition among a multiethnic cohort of older adults. Design, Setting, and Participants In this cross-sectional study, data were collected between September 1, 2017, and May 31, 2022. Participants were from the Health and Aging Brain Study–Health Disparities, which is a community-based single-center study in the Dallas/Fort Worth area of Texas. A total of 1614 Mexican American and non-Hispanic White adults 50 years and older were included. Exposure Neighborhood disadvantage for participants’ current residence was measured by the validated Area Deprivation Index (ADI); ADI Texas state deciles were converted to quintiles, with quintile 1 representing the least disadvantaged area and quintile 5 the most disadvantaged area. Covariates included age, sex, and educational level. Main Outcomes and Measures Performance on cognitive tests assessing memory, language, attention, processing speed, and executive functioning; measures included the Spanish-English Verbal Learning Test (SEVLT) Learning and Delayed Recall subscales; Wechsler Memory Scale, third edition (WMS-III) Digit Span Forward, Digit Span Backward, and Logical Memory 1 and 2 subscales; Trail Making Test (TMT) parts A and B; Digit Symbol Substitution Test (DSST); Letter Fluency; and Animal Naming. Raw scores were used for analyses. Associations between neighborhood disadvantage and neuropsychological performance were examined via demographically adjusted linear regression models stratified by ethnic group. Results Among 1614 older adults (mean [SD] age, 66.3 [8.7] years; 980 women [60.7%]), 853 were Mexican American (mean [SD] age, 63.9 [7.9] years; 566 women [66.4%]), and 761 were non-Hispanic White (mean [SD] age, 69.1 [8.7] years; 414 women [54.4%]). Older Mexican American adults were more likely to reside in the most disadvantaged areas (ADI quintiles 3-5), with 280 individuals (32.8%) living in ADI quintile 5, whereas a large proportion of older non-Hispanic White adults resided in ADI quintile 1 (296 individuals [38.9%]). Mexican American individuals living in more disadvantaged areas had worse performance than those living in ADI quintile 1 on 7 of 11 cognitive tests, including SEVLT Learning (ADI quintile 5: β = −2.50; 95% CI, −4.46 to –0.54), SEVLT Delayed Recall (eg, ADI quintile 3: β = −1.11; 95% CI, −1.97 to –0.24), WMS-III Digit Span Forward (eg, ADI quintile 4: β = −1.14; 95% CI, −1.60 to –0.67), TMT part A (ADI quintile 5: β = 7.85; 95% CI, 1.28-14.42), TMT part B (eg, ADI quintile 5: β = 31.5; 95% CI, 12.16-51.35), Letter Fluency (ADI quintile 4: β = −2.91; 95% CI, −5.39 to −0.43), and DSST (eg, ADI quintile 5: β = −4.45; 95% CI, −6.77 to –2.14). In contrast, only non-Hispanic White individuals living in ADI quintile 4 had worse performance than those living in ADI quintile 1 on 4 of 11 cognitive tests, including SEVLT Learning (β = −2.35; 95% CI, −4.40 to –0.30), SEVLT Delayed Recall (β = −0.95; 95% CI, −1.73 to –0.17), TMT part B (β = 15.95; 95% CI, 2.47-29.44), and DSST (β = −3.96; 95% CI, −6.49 to –1.43). Conclusions and Relevance In this cross-sectional study, aging in a disadvantaged area was associated with worse cognitive functioning, particularly for older Mexican American adults. Future studies examining the implications of exposure to neighborhood disadvantage across the life span will be important for improving cognitive outcomes in diverse populations.